Veterans Rebuilding Life

Registration

Create a Free Account to Access VRL Services & Programs:

ACCOUNT INFORMATION

Last Name

First Name

M.I.

Date of Birth

Street Address

Apartment / Unit #

City

State

Zip Code

Mobile Phone

Email

Are you a citizen of the United States?

YESNO

Have you been convicted of a felony?

YESNO

If no, are you authorized to work in the U.S.?

YESNO

Are you still serving the U.S. Military?

YESNOActiveReserved

If no longer serving, what was your final discharge?

HonorableOther Than HonorableMedicalDishonorable

MILITARY + CIVILIAN EXPERIENCE

Military Position Held

MOS Training + Military Schools

Civilian Trade Certifications + Schools

From

To

Did you graduate?

YESNO

Degree

College?

YESNO

College Attended

From

To

Did you graduate?

YESNO

Degree:

EMPLOYMENT AREAS OF INTEREST

Are you currently employed?

YESNO

If yes?

Full TimePart Time

Name of Employer

Position Held

Dates of Employment

From

To

Please check up to three areas of interest below:

FT/PT Employment

Benefits Registration

Professional Development

Veteran Mentorship

Volunteer Opportunities

Accredited Internships

Attach DD 214 to submit:

File must be 5mb or less, PDF or WordDoc

Upload DD-214:

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